Uso de historias clínicas electrónicas para apoyar el abandono del hábito de fumar
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | Country: USA Setting: Madison, Wisconsin Design: 18 month before and after study measuring change in referral to a telephone quitline. | |
| Participants | Two clinics within a healthcare system: Primary care clinic with 7 physicians; Pulmonary care clinic with 6 physicians. | |
| Interventions | EHR was modified to prompt clinic staff to offer a quitline referral. Secure link was established between patient record and quitline. | |
| Outcomes | Proportion of patients who smoke referred to quitline; acceptance rate by the patient. Data obtained from medical and administrative records. | |
| Notes | Designed as a case study without empirical testing. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Objective data obtained from medical and administrative records using an automated reporting system. |
| Incomplete outcome data (attrition bias) | Low risk | Data were based on electronic records for all patients with a visit. |
| Methods | Country: USA Setting: Portland, Oregon Design: Tracking codes to measure and report tobacco cessation guideline provider activities were introduced in two primary care clinics. One clinic was using an electronic health record and the comparison clinic a paper chart. | |
| Participants | 2 Primary care clinics, one using an internally developed, web‐based electronic health record and another using a paper medical record. | |
| Interventions | The EHR clinic was prompted to ask patients about smoking, give advice to quit, and to document these actions in the EHR. A tracking form was attached to the paper chart in the non‐EHR clinic. | |
| Outcomes | Documentation of tobacco use was collected from a sample of 50 patient charts. Billing and claims databases were used to measure code utilization. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Clinics not randomly allocated |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Objective data extracted by research staff based on a random sample of clinic patients |
| Incomplete outcome data (attrition bias) | Low risk | EMR data included all charts; the comparison clinic was based on a random sample. |
| Methods | Country: USA Setting: Primary care clinics, Portland, Oregon Design: Cluster randomized controlled trial. Clinics were grouped by business affiliation, payer mix, and baseline rate of recorded smoking status (ask rate); then randomized into intervention and control. A case‐mix score was calculated to control for age and illness diagnosis. Regression analysis was performed using generalized estimating equations. Intra‐cluster correlation coefficients (ICC) were calculated for the analysis. | |
| Participants | 19 Primary care clinics (n=10 intervention) using a common electronic health record within one health system. | |
| Interventions | Intervention group clinics received written reports showing individual provider, and clinic performance on tobacco clinical guideline actions: ask, advise, assess, assist, arrange. Written reports were provided monthly to the clinic manager. Control clinics used same EHR without feedback | |
| Outcomes | Outcomes were obtained from electronic files and included estimates of asking about tobacco use, advising to quit, assessing interest in quitting, and assistance with referral to the telephone quitline.
| |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Group randomized, clinics were grouped by pre‐determined criteria prior to randomization |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Low risk | Intervention personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Outcome data were extracted from the EMR on a monthly basis based on all patient visits |
| Incomplete outcome data (attrition bias) | Low risk | Data were collected at the patient level and included all patients |
| Methods | Country: Australia Setting: Urban general practice clinic of 10 physicians; Adelaide Design: Patient randomized study. Data were analysed with regression using generalized estimating equations. | |
| Participants | Intervention sample n=5118; Control sample n=5389; 56% female | |
| Interventions | Reminders for preventive activities including recording smoking status appeared as a field in the electronic health record. | |
| Outcomes | Documentation of smoking status in the electronic health record. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Patients were randomized by family medical record number. 'The baseline characteristics of the patients allocated to the two experimental groups were similar'. Judged at low risk of selection bias. |
| Allocation concealment (selection bias) | Low risk | No opportunity to change allocation, all clinic patients included, no potential for selection bias |
| Blinding of participants and personnel (performance bias) | High risk | All physicians in a single clinic were included. 'The GPs were not blinded to the allocation of patients to the intervention or control groups.' The risk is that all patients could be treated the same regardless of study assignment |
| Blinding of outcome assessment (detection bias) | Low risk | 'Automatic recording of preventive care opportunities and their uptake' |
| Incomplete outcome data (attrition bias) | Low risk | Data collected electronically for all patients. |
| Methods | Country: USA Setting: Boston, Massachusetts Design: Uncontrolled before‐and‐after study. Pre‐intervention period (4 months) was compared to post‐intervention (4 months). | |
| Participants | Admitted hospital patients in a large multi‐specialty hospital affiliated with a University. Records for 17,530 admissions were examined. | |
| Interventions | A series of check boxes (tobacco order set) was added to admission screens of the hospital computerized order‐entry system. The assessment included smoking/nonsmoking, cessation materials, cessation consultation, and orders for nicotine replacement medications or bupropion. | |
| Outcomes | Referral to smoking cessation counselling and ordering cessation medications. | |
| Notes | Effects on smoking status identification could not be assessed as available only in the postintervention period; previously these data were not electronically collected. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | 'NRT orders were obtained from hospital pharmacy records. Smoking counselor consults were obtained from the electronic database kept by hospital smoking counselors.' |
| Incomplete outcome data (attrition bias) | Low risk | Same methods of data collection pre and postintervention |
| Methods | Country: USA Setting: Boston, Massachusetts Design: Cluster randomized controlled trial. Clinics were matched based on size (number of annual visits) and practice type (hospital based, community based, or community health centre) then randomly assigned to intervention or usual care. Intra‐cluster correlation coefficients (ICC) were calculated for the analysis. A generalized linear model controlled for the clusters and possible interactions. | |
| Participants | Documented smokers (n=9589) in 26 Primary care clinics (n=12 intervention) using an internally developed, web‐based electronic health record. | |
| Interventions | Intervention group clinicians experienced three changes to the electronic health record: a cigarette icon on the top of the health record was either black when smoking status was missing or scarlet for current smokers; tobacco treatment reminders were listed in the patient record; and treatment order forms for cessation medication and telephone Quitline referral were added. | |
| Outcomes | Primary outcome was documented smoking cessation counselling (smoking counsellor reached a patient by telephone, or a patient attended a program, or the Quitline reached a patient by telephone). Secondary outcomes included documentation of smoking status, prescribing cessation medication, and referral to cessation treatment, and smokers subsequently documented as non smokers. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Group randomized; clinics were matched on pre‐determined criteria then randomized |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Low risk | Intervention personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Same methods of data collection from electronic records for intervention and control clinics |
| Incomplete outcome data (attrition bias) | Low risk | Methods of data collection makes differential attrition unlikely |
| Methods | Country: USA Setting: Madison, Wisconsin Design: Uncontrolled before‐and‐after study. Pre‐intervention period (12 months) was compared to post‐intervention (12 months). Chi² tests were performed. | |
| Participants | Primary care patients attending 18 general internal medicine and family medicine clinics. About 250,000 patient visits were examined pre and post intervention. | |
| Interventions | A tobacco use box was added to the vital signs patient window; if a tobacco user was identified, the patient was asked if they were willing to talk to the doctor about quitting: if yes, a three question paper survey asked about past cessation medication use, cigarettes used per day, and a possible quit date. This survey was left for the physician to review during the visit. | |
| Outcomes | Assessment of smoking status pre‐post from the electronic health record; proportion provided medication (post intervention only), clinician documentation of smoking cessation counselling (post intervention only). | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Data automatically generated from EHR |
| Incomplete outcome data (attrition bias) | Low risk | Data collected electronically. |
| Methods | Country: USA Setting: Chicago, Illinois Design: before and after study involving cohort and cross sectional smokers. | |
| Participants | Single urban primary care practice; 37 attending and 78 resident physicians. 1,349 documented smokers in preintervention cohort, 1,346 in postintervention cohort. 764 included in both cohorts | |
| Interventions | A smoking cessation alert was added to the EHR. The alert prompted physician actions including a medication order set. | |
| Outcomes | Change in orders of prescription for cessation medications; change in referral to cessation counselling. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Objective data extracted from EHR, although assessors not blind to whether pre‐ or post‐intervention |
| Incomplete outcome data (attrition bias) | Low risk | Same methods of data extraction pre and postintervention |
| Methods | Country: USA Setting: Chapel Hill, North Carolina Design: Uncontrolled before‐and‐after study. Pre‐intervention period (4 months) was compared to post‐intervention (8 months). Chi² tests were performed. | |
| Participants | Primary care patients attending 3 family medicine clinics (n=899) | |
| Interventions | Two questions were added to the patient vital signs in the electronic health record – “Current smoker?” and “Plan to quit?” | |
| Outcomes | Documented smoking status, assessment of quit plan, and smoking cessation counselling recorded in the electronic health record. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Researchers extracted objective data from randomly selected medical records |
| Incomplete outcome data (attrition bias) | Low risk | Same methods of data collection pre and postintervention |
| Methods | Country: USA Setting: Columbia, South Carolina Design: Uncontrolled before‐and‐after study. Pre‐intervention period (4 months) was compared to post‐intervention (8 months). Pharmacist delivered intervention during drug therapy management. | |
| Participants | Anticoagulation patients or diabetes patients who were current smokers (n=90) attending 3 University‐based primary care clinics. | |
| Interventions | A smoking template was added to the pharmacy‐related progress notes within the electronic health record. The template queried on smoking status, type of tobacco, amount of tobacco, years of tobacco use, past quit attempts, desire to quit, and assessment of nicotine addiction. Based on smoking status, pharmacist provided a message on the benefits of smoking cessation and education on cessation medications. | |
| Outcomes | Smoking cessation and readiness to quit smoking if not quit. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Uncontrolled study |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | High risk | Patients reported their smoking status without validation |
| Incomplete outcome data (attrition bias) | Unclear risk | Unclear whether any smokers identified at baseline were not followed up |
| Methods | Country: USA Setting: Minneapolis, Minnesota Design: A two‐arm group randomized trial with dental clinics assigned to an enhanced dental record intervention or usual care control. | |
| Participants | 15 dental clinics. Prior to randomizations, clinics were stratified by size, proportion smoking, and public vs private insurance. | |
| Interventions | In the enhanced condition, the EDR was modified to prompt providers to ask and discuss smoking and interest in quitting. | |
| Outcomes | Change in provider actions ‐‐ ask, discuss quitting, refer to quitline. | |
| Notes | No follow‐up as patients were called a few days after their visit. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Stratified and group randomization of all clinics in a dental system |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Unclear risk | Personnel not blind to change in EHR by design, dentists only worked at a single clinic, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Unclear risk | Patient reported outcomes. Unclear whether patients or assessors blind to EDR condition |
| Incomplete outcome data (attrition bias) | Low risk | Similar proportion of patients of intervention and control clinics reached |
| Methods | Country: USA Setting: Los Angeles, California and Palo Alto, California Design: group randomized clinical trial. Regression analysis performed; no assessment of group correlation. | |
| Participants | 18 Primary care clinics (n=10 intervention) affiliated with the Veterans Health Administration (VA). | |
| Interventions | A simplified method was added to an existing electronic health record for referral to telephone‐based cessation counselling. Electronic mail reminders were sent to providers. Project staff promoted the referral tool during visits to the intervention clinics. | |
| Outcomes | Primary outcome was provider self reported referrals to telephone‐based cessation counselling. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomly assigned, stratified by region (Northern vs Southern California) and size (large vs small) |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | High risk | The change to the electronic record could not be restricted in control clinics so access to the intervention was incompletely controlled. |
| Blinding of outcome assessment (detection bias) | High risk | Self reported outcome from providers surveyed about their referral patterns |
| Incomplete outcome data (attrition bias) | High risk | Not all providers responded to surveys. |
| Selective reporting (reporting bias) | High risk | Referral rate was reported for intervention but not control clinics |
| Methods | Country: USA Setting: Eau Claire, Wisconsin Design: Uncontrolled before‐and‐after study. Pre‐intervention period (9 months) was compared to post‐intervention (19 months). | |
| Participants | Primary care patients attending a single family medicine clinic affiliated with a university. | |
| Interventions | Smoking status was documented in a single location – the major problem list in the electronic health record. Medical Assistants were assigned the role of documenting smoking status and providing cessation education. | |
| Outcomes | Documentation of smoking status and cessation counselling by clinicians. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No control group |
| Allocation concealment (selection bias) | High risk | As above |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Unclear risk | Different source of data before and after the EHR change |
| Methods | Country: USA Setting: Detroit, Michigan Design: Controlled before‐and‐after study. Pre‐intervention data collection (9 weeks) and post intervention data collection (14 weeks). Two intervention clinics were compared to 4 control clinics. Regression analysis controlled for baseline demographics and co‐morbidities. Patient surveys were completed at baseline and 2 weeks following a visit in the post‐intervention period. | |
| Participants | Primary care patients attending 6 primary care clinics (2 intervention, 2 vital sign check in screen only, 2 control). These clinics form part of a large healthcare system. Clinics were selected based on convenience and size. | |
| Interventions | Screens were added to the electronic health record. A vital sign entry recorded smoking status and willingness to quit. Further screens were automated to provide information to the provider, suggested dialogue to use, and encouraged referral to a smoking cessation program. | |
| Outcomes | Documentation of clinician actions – ask, advise, assess, assist, arrange based on patient surveys. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Non randomized. Clinics were selected on ability to participate; there were baseline differences in patient characteristics |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Unclear risk | No information |
| Blinding of outcome assessment (detection bias) | Unclear risk | Patients interviewed by telephone after clinic visits, unclear whether they or interviewers were blind to clinic condition |
| Incomplete outcome data (attrition bias) | Unclear risk | No details about proportion of clinic attenders who were successfully contacted |
| Methods | Country: USA Setting: Houston, Texas Design: pair‐matched two‐arm group randomized trial | |
| Participants | 10 community health clinics (described as safety net clinics) matched on patient volume, age, gender, race/ethnicity, and SES. | |
| Interventions | Intervention clinics trained nursing staff to assess quitting interest and connect interested smokers to the quitline. The quitline then called smokers. Control clinics gave smokers a quitline referral card. | |
| Outcomes | Proportion of smokers enrolled in treatment with the quitline. | |
| Notes | Clinic selection not reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomized after pairing on patient volume, smoking prevalence, mean age and sex distribution |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Objective outcomes using data supplied by quitline |
| Incomplete outcome data (attrition bias) | Unclear risk | Control clinics patient outcomes relied on names of quitline referrals being correctly matched to quitline callers. |
| Methods | Country: USA Setting: Houston, Texas Design: Pair‐matched two arm group randomized trial | |
| Participants | 10 family practice clinics from a large network of clinics. | |
| Interventions | Intervention clinics linked interested smokers through the EHR to the quitline. The quitline proactively called the smokers. | |
| Outcomes | Proportion of smokers enrolled in treatment with the quitline. | |
| Notes | Clinic selection not reported | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomized after pairing on patient volume, smoking prevalence, mean age and sex distribution |
| Allocation concealment (selection bias) | Low risk | Clinics assigned at baseline, defined patient populations, no risk of differential patient recruitment |
| Blinding of participants and personnel (performance bias) | Low risk | Personnel not blind to change in EHR by design, risk of bias judged low |
| Blinding of outcome assessment (detection bias) | Low risk | Objective outcomes using data supplied by quitline |
| Incomplete outcome data (attrition bias) | Low risk | Control clinics patient outcomes relied on names of quitline referrals being correctly matched to quitline callers. |
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Single clinic with non random surveys of patients | |
| The EHR effect was confounded by staff training effect | |
| Outcome measure not well defined; limited to documentation of smoking | |
| Observational study with significant selection bias and without a focus on smoking | |
| EHR changes could not be separated from pay for performance changes | |
| Single site pilot study with selection bias | |
| Single site, observational study with no useful data on smoking intervention | |
| EHR improvements coincided with staffing changes and patient volume changes | |
| Study was a test of performance feedback with the EHR as the source of the feedback | |
| This was a feasability study that did not test EHR changes |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1 All outcomes Show forest plot | Other data | No numeric data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 1.1
Comparison 1 Study results, Outcome 1 All outcomes. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1.1 Randomized controlled trials | Other data | No numeric data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1.2 Controlled trials | Other data | No numeric data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1.3 Uncontrolled trials | Other data | No numeric data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Study flow diagram for update 2014
| Study | Smoking cessation | Guideline recommended actions |
| Randomized controlled trials | ||
| Bentz 2007 | Guideline actions increased within the intervention clinics for smoking status (94.5% vs 88.1% p<0.05), advised to quit (71.6% vs 52.7%, p<0.001), assessed interest in quitting 65.5% vs 40.1% p<0.001), and provided assistance (20.1% vs 10.5%, p < 0.001). Quitline referral increased in the intervention clinics (adjusted OR 1.53) | |
| Linder 2009 | Significantly more smokers in the intervention clinics were subsequently documented as nonsmokers compared to smokers in the control clinics (5.3% vs 1.9%, p < 0.001) | Significantly more smokers were referred to cessation counselling in the intervention clinics (4.5% vs 0.4% in control clinics, p<0.001), and significantly more smokers from intervention clinics made contact with a cessation counsellor (3.9% vs 0.3% in control clinics, p<0.001). No difference in the proportion of documented smokers from control or intervention clinics prescribed any cessation medication (2.0% vs 2.0%). |
| Rindal 2013 | Significantly more smoking patients from intervention clinics versus control clinic patients reported dental provider actions: discussed interest in quitting (87% vs 70%); discussed quitting (47% vs 26%); and referral to quitline (37% vs 17%). | |
| Sherman 2008 | The average number of smokers per month referred to telephone counselling increased from 1.0 to 15.6 (p< 0.001) among intervention clinic providers, and from 0.2 to 0.7 (p<0.04) among control clinic providers. | |
| Vidrine 2013 | Patients from intervention clinics were more likely to enroll in quitline treatment compared to control clinics (15% vs 0.5%). | |
| Vidrine 2013a | Patients from intervention clinics were more likely to enroll in quitline treatment compared to control clinics (8% vs 0.6%). | |
| Controlled trials | ||
| Bentz 2002 | Documentation of tobacco use was unchanged in the paper chart clinic, but increased from 79% to 88% in the enhanced EHR clinic. | |
| Frank 2004 | Assessment of smoking status was unchanged between intervention and control patient visits (2.0% vs 1.8%, RR 1.12 , 95% CI 0.90 to 1.39). | |
| Szpunar 2006 | Asking about tobacco use increased in the intervention clinics from 88.4% to 92.8%. | |
| Uncontrolled trials | ||
| Adsit 2014 | The proportion of patients referred to the quitline increased from <1% to 14%. 5% enrolled in quitline treatment. | |
| Koplan 2008 | The proportion of smoking patients referred to cessation counselling increased from 0.8% to 2.1% (p < 0.001); medication ordered increased from 1.6% to 2.5% (p < 0.001). | |
| Lindholm 2010 | Tobacco use status in the EHR increased from 71.6% to 78.4% (p < 0.001). | |
| Mathias 2012 | The percentage of documented smokers with a change in smoking status from active to quit during the pre‐ or postintervention period increased from 17.1% in the preintervention cohort to 20.5% in the postintervention cohort (p = .06) | In the post enhancement period, cessation medication prescribing did not change (14.4% vs. 13.4%, p = .5), but quitline referral increased from 2% to 7% (p < 0.001). |
| McCullough 2009 | Tobacco use status increased from 71% to 84% (p < 0.001). Assessement of plan to quit increased from 25.% to 51% (p < 0.005), and smokers assessed for a plan to quit were more likely to receive cessation counselling (46% vs 14% among smokers not assessed, p < 0.001). | |
| Ragucci 2009 | Of 90 smokers in the study, 29 were quit at 6 months (32%) | |
| Spencer 1999 | Recording of tobacco use status increased from 18.4% to 80.3%. | |
Comparison 1 Study results, Outcome 1 All outcomes.
| Use of electronic health records to support smoking cessation | ||||
| Patient or population: People who smoke Settings: Healthcare clinics Intervention: Any use of an Electronic Health Record (EHR) to improve smoking status documentation or cessation assistance for patients who use tobacco, either by direct action or by feedback of clinical performance measures. Comparison: No EHR, or EHR without support for smoking cessation intervention | ||||
| Outcomes | Effect | No of Participants | Quality of the evidence | Comments |
| Smoking cessation | More intervention clinic than control clinic smokers quit (5.3% vs 1.9%, p < 0.001) | 1 cluster RCT, 26 clinics | ⊕⊝⊝⊝ very low1 | Indirect measurement based on EHR documentation of smoking status |
| Guideline recommended actions | Studies typically showed positive effects on outcomes including documenting smoking status, giving advice to quit, assessing interest in quitting, and providing assistance including referral. | 6 cluster RCTs, 98 clinics | ⊕⊕⊕⊝ Moderate2 | Studies did not all assess the same outcomes. Non randomized and uncontrolled studies also showed positive effects |
| GRADE Working Group grades of evidence | ||||
| 1 Only one study reported the outcome, and did not use direct patient report of cessation 2 Heterogeneity in the interventions and targeted behaviours | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All outcomes Show forest plot | Other data | No numeric data | ||
| 1.1 Randomized controlled trials | Other data | No numeric data | ||
| 1.2 Controlled trials | Other data | No numeric data | ||
| 1.3 Uncontrolled trials | Other data | No numeric data | ||
